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State of Mind: Yale Students Contend with Barriers to Mental Health Counseling

“I have dealt with mental health stuff—depression, anxiety—in the past,” Catherine said. “I was like, if I can have free mental health counseling, and I’m living on my own for the first time, I should be proactive about this.”

Catherine Rutherfurd ’22 called Yale Health on September 1, 2018 to express her interest in finding a therapist. “There was no available appointment for three weeks. They were just busy,” Catherine explained. She was seen for only a preliminary consultation, during which a practitioner evaluated her mental state, on September 19.

After the consultation, Catherine was told it would be a matter of days before she was matched with a therapist.

Almost two weeks later, the practitioner responded.

“I’ve been told you should still hear from someone in the next couple days but I understand you are anxious to get started! I’m sorry it’s taken a little longer than I expected,” he wrote in an email.

But Catherine received no news. One month later, Catherine wrote him again.

She finally heard back with the name of her therapist in December. She had waited for nine weeks.***

Catherine’s case is not unique. At Yale, students seeking mental health services often wait months to receive support. The Yale College Council (YCC) 2018 Mental Health Report found that only 31.5 percent of students agreed that the length of time they waited before receiving help was reasonable. Yale Health does not publish data on student wait times.

The long wait times point to a larger problem: Yale lacks sufficient resources to meet  students’ increased demand for counseling. For Yale University’s student body of 12,385, the Yale Mental Health & Counseling website only lists 34 full-time therapists.

Campuses across the country are facing the same problem. According to a 2015 report by the Center for Collegiate Mental Health, the number of students who visited campus counseling centers between fall 2009 and spring 2015 grew by 30 percent. In response, colleges like Yale are strained to meet their students’ needs.

But as colleges scramble, students struggle. Paul Mitrani, clinical director at the Child Mind Institute in New York, a clinical practice for children facing mental health and learning disorders, says that such long wait times are detrimental. “Students are not getting the help they need. And the problem with that is that the day you see a psychiatrist, that’s not the day you start getting better,” he told The Politic.

Nance Roy, the chief clinical officer of the Jed Foundation, an organization committed to mental health on college campuses, also pointed out that long wait times might turn away students altogether: “It sometimes takes a student a while to actually go for help. They may feel ambivalent, scared, uncertain, so when they actually take the step to reach out for help, it can be discouraging to learn that one has to wait. They may ultimately decide not to return.”

Students who are proactive in reaching out for mental health counseling often see their conditions worsen while they are waiting, defeating the purpose of their early attempts to get support.

Jazzie Kennedy ’20 felt that way. Jazzie had been to Yale Health as a first-year, when she was feeling overwhelmed with school. Though she had to wait a month to get assigned a therapist, she found the services helpful once she received them. But she stopped going the following year. “I think I just went into sophomore year and assumed that everything was fine,” she said.

Things were not fine, and she struggled with depression that winter. Jazzie decided to seek help at the beginning of her junior year. “I made a proactive effort to reach out in advance,” she said.

As Jazzie waited to hear back from Yale Health, her decision to seek out mental health services became less of a precautionary measure and more of a necessity. Her dog passed away in September, and she felt herself spiraling as a result. “That’s when I really felt like I need to talk to someone because I was grieving and it sucked,” she said.

But she was not assigned a therapist until October, despite attempts to expedite the process by reaching out to a family friend who holds a senior position at Yale Health. “I don’t even know how much longer it could have taken for everyone else,” Jazzie said.

***

“I never really had access to [mental health] resources back home,” said Aaron ’19, who requested a pseudonym to preserve his anonymity. “I’m from a community that didn’t necessarily smile upon those kinds of things, so it was my first access to them.”

Aaron, now a sophomore, sought help from Yale Health in the fall of his first year. He reached out in September and wasn’t matched until November. “That’s a comparatively short turnaround,” he said, based on conversations with his peers.

After waiting for over a month, Aaron finally decided to call Yale Health. “I wasn’t getting anywhere, and I was getting frustrated with it,” he said.

Aaron was matched with a therapist shortly after the phone call. “I’m pretty confident I was bumped to the front of the line because I reached a very sympathetic person and I was in a not-great place when I called,” Aaron explained. “I think that a hysterical male voice is something that they’re not necessarily used to, and so they responded quite urgently to that.”

Though Aaron is grateful for the services that he has received, he expressed taking issue with the fact that his phone call might have allowed him, a male, to be seen faster than his peers: “I always felt weird about the fact that I got shot to the front of the line because of the urgency of the call. I think that shows a problem because I was probably more comfortable getting louder due to my privilege. I think that probably leads to a lot of people getting shut out.”

Heidi Dong ’20, the YCC vice president, emphasizes in an interview with The Politic that placing that first phone call for help can be difficult for students: “It’s hard for someone to say, ‘I’m going to call this number, and someone on the other end is going to tell me what to do and who to see.’”

Catherine recognized that, when reminding mental health services to match her with a therapist, she might have been more effective calling than emailing Yale Health. Nonetheless, she chose not to call. “I didn’t try calling because part of my [anxiety] is I really hate making appointments over the phone.” She also mentioned an additional barrier: there were few private spaces at Yale where she felt comfortable calling. “How am I supposed to make a phone call like, ‘Hi, I have mental health problems,’ so that the rest of my suite can hear me talk?” Catherine said.

***

Emma ’21, whose name has been changed to preserve privacy, has had to talk about her post-traumatic stress disorder (PTSD) to at least three people at Yale Health: her first therapist, her second therapist, and her psychiatrist.

“I had to explain my trauma over and over to people, and that kind of sucks,” she said. “It’s like, I already hashed it out with therapist number one, now we’re onto therapist number two. I’m not getting emotional about it now because it’s very much rehearsed. But I feel like the whole point of therapy is that you get emotional.”

Emma decided to seek mental health support in the fall of her sophomore year after struggling with anxiety throughout her first year at Yale. “I kind of thought that denying everything was easier—like pretending it’s not there means it’s not there,” she explained. Emma took a diagnostic exam on Yale Health’s website, and the results said she had anxiety, depression, and PTSD. She took the test two more times, got identical outcomes, and picked up the phone to make an appointment.

For Emma, the problem was not waiting to be matched with a therapist (the person who performed her diagnostic made her an appointment right away), but unresponsiveness from the therapist she was assigned. “She ghosted me, and I emailed her several times,” Emma explained. “I left notes at the [Yale Health front] desk to make an appointment with her. I called her several times. No response.”

The therapist had referred Emma to a psychiatrist who could prescribe her medication as she went through therapy. For a long period the psychiatrist—whose sole stated job was to prescribe medication, not provide counseling—was the only mental health professional Emma consistently saw.

“So like, I’m being medicated but I’m not in therapy,” Emma said. The psychiatrist started to see Emma for longer sessions and do therapy with her—going beyond her official duties—while Emma’s transfer request for a more responsive therapist was being processed.

Finally, Emma was assigned a new therapist. But that doctor didn’t have much time for her either. She encouraged Emma to book appointments every other week, instead of weekly. But for Emma, 45 minutes twice a month was not sufficient.

“It takes a solid three or four sessions just to explain all the stuff that’s going on because it’s not just like I come in this week with a new set of issues. I come in this week with a  set of issues that I’ve had for the past ten years,” Emma explained.“Forty-five minutes every other week? It’s going to take us forever to get there.

Mitrani explained that with such infrequent sessions, there will be “no progress toward what [patients and therapists] are working on.”

Emma has to spend so much of each session explaining her anxiety that little time remains for the therapist to offer coping mechanisms for the next time Emma starts having a panic attack.

“I honestly think that my mental health has gotten worse since going to Yale Health,” Emma said. “Because I think that half-assing therapy is worse than not doing therapy at all. Repressing and compartmentalizing work really well, and I’m really good at that. But when you’re asking me to bring stuff up every other week that I don’t want to talk about and I’m not processing it, but when I leave, I’m freaking out about it, then that’s not really healthy.”

***

In April 2019, Emma’s psychiatrist became a Yale Health therapist, and they now meet every week. “I’m at a better place at Yale Health now than I was three months ago,” she said.

After students interviewed for this story, like Aaron and Catherine, were finally matched with a therapist, their impression of the services they received at Yale Health were more positive.

“I don’t think it was necessarily life-changing or a very great experience. But it was definitely something that made me think about issues that were on my mind once a week, and that was probably good,” Aaron said. “I think the biggest cathartic part of it was the very basic fact of just having another body that was confidential.”

Catherine was more positive about her experience with her specific therapist: “The fact that I found such a good person and we clicked immediately—it’s rare, and that’s very lucky.”

For Catherine, part of what made her therapist such a good match was her familiarity. “I have a middle-aged white lady as my therapist, and that’s the person I trust most in my life—a middle-aged white woman, my mother,” she explains. “If I was a different race or gender, I might prefer someone different.”

Many students who have sought help at Yale Health cite the lack of diversity as a major barrier to receiving the services they needed. The coverage gap was so pronounced that, according to students involved in the Afro-American Cultural Center, Director Risë Nelson took it upon herself to distribute a list of Black therapists in the Greater New Haven Area.

***

According to Heidi, the directors of Yale Health are aware of student criticisms of the school’s Mental Health & Counseling services. But it is unclear if Yale Health staff understand the depth of the problem or what exactly they are doing to try to fix it.

Yale Health clinicians refused to comment for this story and instead deferred to the director of Mental Health & Counseling, Lorraine Siggins. Siggins has not responded to repeated requests for comment.

The Mental Health Advisory Committee, which was formed by Yale Health in 2013 after the YCC released its first report on mental health, is the only avenue through which students can engage with Yale Health on matters of institutional policy. Heidi, a member of the student committee, says this is likely for “consolidation” purposes.

“There are a lot of people who want to work on mental health, so [Yale Health prefers] to have those people bring things to them in those meetings,” she explains.

But Saloni Rao ’20, the YCC president, sees many flaws in this centralized system: “What’s especially frustrating is that [Yale Health] is in charge of convening the committee because it’s a student advisory group for them, not an advocacy group like the YCC.” She says that the committee was convened for the first time in February this academic year.

“It’s the YCC’s job to advocate on behalf of all students, and we’re trained in how to have meetings that result in actionable change. I don’t know if students on this advisory committee position themselves in the same way,” Saloni explained.

Although the advisory committee has helped initiate reforms, such as changes to the Mental Health & Counseling website, committee member Audrey Huang ’21 acknowledged the body’s limitations: “The most we can do is say, ‘Based on YCC survey data and our personal experiences, here are things we’d like to see happen,’ and at most they can say yes or no, but ultimately, it’s not up to us.”

As a result, Audrey has been looking for other ways to get involved in mental health advocacy on campus, such as through mental health-related clubs and publications.

Emma shared the concern that student voices are being silenced: “I feel like the university at least makes an attempt in other areas to make us feel like we’re being heard. But there’s nothing on this end. It just feels like they don’t care.”

***

Aaron believes that Yale has the resources to provide adequate mental health services but is instead choosing to spend them on unnecessary luxuries.

The first-year dinner, for example, included the Parade of Comestibles. “Let’s get rid of the bullshit,” Aaron said. “Let’s say, ‘We’re going to get rid of all these things and life’s going to get a little more bare-bones, and in response, we are going to give you enough mental health counseling.’”

Emma feels the same way: “We have so much money. We can get some more therapists.”

Students recognize that Yale has taken major steps to improve student wellness on campus with initiatives such as the Good Life Center, a space for naps, tea, and meditation in Silliman College. But many see that as only a start. “Wellness is not mental health,” Rao said. “But it does go hand in hand.”

With regard to Mental Health & Counseling, there are practical limitations to what Yale can do, at least with its existing infrastructure. Dong explains that Yale Health’s building has a finite number of rooms and can therefore have only so many clinicians.

Roy said that there are alternatives to increasing the number of therapists, such as establishing triage systems through which students could be evaluated immediately to determine the severity of their mental health issues. “This is effective in catching those students who are in crisis or need urgent care and making sure they do not have to wait for help,” she explained.

She also recommended that universities use online programs that enable students to access resources at any time of day and establish relationships with nearby counseling centers so that they can provide quick referrals for students in need.

It is unclear whether Yale is seeking to implement these measures, but Dong believes the university is not just sitting idly by. “There are important conversations happening,” she said.

But Catherine was blunt: “All of us are struggling here. This place is hard. And if this place is hard, you better have some things that are going to support us besides the damn Good Life Center.”